Mid-Term Outcomes of an Alternative Remodelling Technique for Aortic Root Replacement Without Coronary Ostial Mobilisation or Reimplantation

Background: We compare the early and late outcomes of a modified aortic root remodelling (ARR) technique for aortic root replacement without mobilisation or reimplantation of the coronary ostia, with those of the modified Bentall procedure. Methods: : A retrospective observational study was performed comprising 181 consecutive patients who underwent aortic root replacement with a Bentall procedure (104 patients) or ARR (77 patients) between January 2013 and December 2019. Primary endpoints included hospital mortality and late survival. Secondary endpoints included incidence of post-operative complications and freedom from late re-operation. Results: : ARR procedures were performed with shorter cross-clamp times and comparable cardiopulmonary bypass times to Bentall procedures. The incidence of early post-complications was comparable between groups. 30-day mortality was numerically lower with ARR than Bentall procedure. Over 7-year follow-up, 4 patients (3.8%) required repeat aortic surgery after Bentall procedure, and none after ARR. Long-term mortality after ARR and after Bentall procedures was 17.1% and 22.7%, respectively. The cumulative incidence of reintervention on the aortic root/valve was 3.2% after a Bentall procedure and 0% after ARR. When adjusted for other independent risk factors, late mortality was not influenced by the procedure performed, although competing risk adjusted for age showed that Bentall procedure was associated with an increased risk of aortic root/aortic valve re-operation. Conclusions: : The modified ARR technique is associated with reduced myocardial ischaemia time, lower post-operative mortality and aortic re-intervention rates compared to a Bentall procedure. It may be considered a safe and feasible procedure for aortic root/ascending aortic replacement offering good long-term outcomes.